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Abstract

Background: Because of their renal clearance, two commonly used anti-thrombotics in percutaneous coronary interventions (PCI), eptifibatide and enoxaparin, are relatively contra-indicated in dialysis patients. Whether these agents are used among dialysis patients in routine clinical practice and are associated with adverse outcomes is unknown.

Methods: In the Cath-PCI registry, 24,711 dialysis patients underwent PCI between 2004 and 2008. Contrain-dicated anti-thrombotics included eptifibatide and enoxaparin. Dialysis patients receiving contraindicated anti-thrombotics were compared to dialysis patients not receiving them. The main outcome measures were major in-hospital bleeding and death.

Results: Overall, 5084 (22.3%) patients received enoxaparin or eptifibatide. Of these, 2375 (46.7%) received enoxaparin, 3261 (64.1%) received eptifibatide and 552 (10.9%) received both. Compared to patients who did not receive a contraindicated anti-thrombotic, patients who received a contraindicated anti-thrombotic had significantly higher in-hospital bleeding (5.5% vs 3.0%, p<0.01) and death (6.5% vs 3.9%, p<0.01). After multivariate adjustment, patients receiving contraindicated anti-thrombotics had higher risks of in-hospital bleeding and death compared to those not receiving them (figure⇓). These risks appeared to be higher with enoxaparin than with eptifibatide.

Conclusion: Approximately 1 in 4 dialysis patients receiving PCI are treated with contraindicated anti-thrombotics which are associated with higher rates of in-hospital bleeding and death. Interventions are needed to reduce the use of these agents among dialysis patients receiving PCI.